VBS Sign-Up

[vc_row][vc_column][vc_column_text]

Online registration closes June 14!

[/vc_column_text][vc_column_text]

Child's Name:*
Phone:*
-
Birthday:*
Gender:*
Grade Completed:*
Do you attend church? If so, where?
Will you be attending VBS with a friend?
Friend's Name:
Friend's Grade Completed:
Additional Info:
Allergies?
Address:*
Mother/Guardian:*
Father/Guardian:
Mother/Guardian Contact Number:
-
Father/Guardian Contact Number:
-
Will you be picking up your child?:*
If no, who is authorized?
If your child is photographed, may we have permission to use your child’s photograph for the purpose of promotion?*
If a medical emergency should arise with my child and I cannot be contacted, I hereby give permission to a licensed CPR/First Aid coordinator/teacher to administer CPR and/or First Aid, and permission to the coordinator/teacher to select a physician and/or hospital for my child’s care. I hereby also give the hospital and/or physician, as selected by the coordinator/teacher, my permission to hospitalize, treat, and to order injections, anesthesia, and/or surgery for my child, whose name appears on this form.Upon arrival the first day of VBS, please come in and sign this form. We will have it printed and available for you to sign.


[/vc_column_text][/vc_column][/vc_row][vc_row][vc_column][vc_column_text][/vc_column_text][/vc_column][/vc_row]